EP1474071B1 - Systeme d'arthroplastie avec interposition - Google Patents

Systeme d'arthroplastie avec interposition Download PDF

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Publication number
EP1474071B1
EP1474071B1 EP03703997A EP03703997A EP1474071B1 EP 1474071 B1 EP1474071 B1 EP 1474071B1 EP 03703997 A EP03703997 A EP 03703997A EP 03703997 A EP03703997 A EP 03703997A EP 1474071 B1 EP1474071 B1 EP 1474071B1
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EP
European Patent Office
Prior art keywords
implant
preformed
component
vivo
tibial
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP03703997A
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German (de)
English (en)
Other versions
EP1474071A2 (fr
EP1474071A4 (fr
Inventor
Jeffrey C. Felt
Mark A. Rydell
Paul J. Buscemi
Alexander Arsenyev
Christopher H. Porter
Laurie E. Lynch
Kristin M. Mortenson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ABS Corp
Original Assignee
ABS Corp
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Filing date
Publication date
Priority claimed from US10/098,601 external-priority patent/US20020127264A1/en
Priority claimed from US10/167,372 external-priority patent/US20020156531A1/en
Application filed by ABS Corp filed Critical ABS Corp
Publication of EP1474071A2 publication Critical patent/EP1474071A2/fr
Publication of EP1474071A4 publication Critical patent/EP1474071A4/fr
Application granted granted Critical
Publication of EP1474071B1 publication Critical patent/EP1474071B1/fr
Anticipated expiration legal-status Critical
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    • A61F2002/4251—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for metacarpo-phalangeal joints, i.e. MCP or MP joints, e.g. knuckle joints
    • A61F2002/4253—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for metacarpo-phalangeal joints, i.e. MCP or MP joints, e.g. knuckle joints for thumbs
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2250/0023—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in porosity
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    • A61F2250/0036—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in thickness
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    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/24—Materials or treatment for tissue regeneration for joint reconstruction

Definitions

  • the mold material can itself become integral to the body of the cured biomaterial.”
  • Such a metallic device as described in either the Fell patent and/or Sulzer's product literature, is described as appropriate for use in younger patients with moderate to severe chondromalacia, particularly since the product provides a hard, self-centering meniscal device that is "devoid of physical means that fix its location".
  • the device of Fell et al. tends to require a significant amount of intact cartilage and meniscus.
  • Applicant's own products to date, including those improved embodiments described herein have been largely geared toward more elderly patients, where such healthy cartilage is lacking.
  • Applicant's devices tend to provide angular correction and improved anchoring of the implant at the joint surface.
  • the present invention includes a variety of embodiments, each of which preferably includes one or more components that are formed ex vivo, and that are adapted to be inserted and finally formed or assembled in situ in order to provide a final prosthesis and articulating joint surface.
  • the various embodiments include, for instance,
  • the implant can be prepared (including fully cured) ex vivo, for later implantation.
  • the present invention therefore provides an implant that is designed to be formed to and congruent with the tibial surface, having a final femoral surface shape that serves largely as a glide path with respect to the femoral condyle.
  • Such a device can be used in patients having joints that have progressed to the stage of "bone on bone", and thus provides a replacement for the function of articular cartilage as well as meniscus, and particularly at the central weight-bearing area, in order to restore alignment, providing an elastomeric, cushioning function.
  • a preferred implant of this type is also congruent with the tibial surface, based upon both its initial shape, together with whatever final shaping may occur in situ.
  • the present implant is more permanently anchored in place, in significant part by one or more posterior projections, such as the posterior lip shown in Figures 1 , and 12 - 13 as well by the optional but preferred use of anterior fixation means (such as embedded sutures).
  • such an embodiment includes a unique combination of a femoral glide path and convexity of the tibial surface of the implant, together with a posterior mesial lip.
  • the implant provides an indentation adapted to accommodate the tibial spine, which together with a slight feathering of the implant on the underside at the tibial spine, the general kidney shape of the implant, and the convexity of the tibial surface, will permit the implant to be congruent with the concave tibia and the posterior mesial lip that extends over the posterior portion of the tibia and into the mesial side of the tibia into the PCL fossa of the tibia.
  • the word "cure”, and inflections thereof, will refer to the extent to which a curable biomaterial, as used to form a component of this invention, has begun or completed whatever physical- chemical reactions may be contemplated in the course of fully forming the component, prior to or at the surgical site, for long term use in situ.
  • the biomaterial can be considered as uncured (as in component parts that have not yet been mixed or compositions that have not yet been activated), or it can be partially cured (e.g., wherein the components have been mixed, or compositions activated, under conditions suitable to begin the curing process), or it can be fully cured (e.g., in which case, whatever chemical reactions may have occurred have substantially subsided).
  • uncured compositions are sterile, storage stable, and often flowable, though are typically not yet formed or capable of being formed.
  • Curing compositions generally begin as flowable compositions, but become nonflowable over a finite time period as they begin to gel or set. Curing compositions can also be minimally formed, e.g., outside the body by the use of molds and/or suitable shaping tools, and/or within the body, as by the initial positioning of the component on supporting bone and by the repositioning of opposing, articulating bone surfaces. Thereafter, it is contemplated and possible that some compositions of this invention can be further formed, over time, as by the gradual effect of articulating bone in the course of long term use.
  • a component can be "specifically” formed in this manner in order to conform the component (and particularly its surfaces) to the corresponding specific shapes and dimensions of bone in situ, including both supporting bone surfaces and/or-opposing (e.g., articulating) bone surfaces.
  • Such specific conformation can be used to improve a variety of characteristics of the final implant, including comfort, mechanical performance, and/or long term stability.
  • Such conformation can also include aspects in which one or more components, or the composite prosthesis, are "conformed” in correspondence with the joint site (e.g., by final shaping and curing processes that occur in situ).
  • Such conformation can also include aspects in which the components, or prosthesis itself, are adapted to be "deformed” within the site, as by the application of force.
  • a substantially fully formed component can be provided to have sufficient mechanical properties (e.g., strength and resilience) to permit it to be inserted into a joint site and effectively deformed under normal anatomic forces
  • a substantially convex component can be deformed to assume the corresponding concave shape in situ, in , while retaining sufficient resilient strength to tend towards its original convex shape (e.g., analogous to the manner in which a locking washer can be deformed in use, while tending toward its original shape).
  • a preformed composition is provided; formed initially by the ex vivo onset of cure, in which the composition can be implanted within on the order of 10 seconds to several days of the onset of cure, preferably within about 30 seconds to about 10 minutes, and more preferably within about one to about five minutes, while maintaining a surface exotherm of less than about 50C, and more preferably less than about 45C once positioned within the body.
  • a particularly preferred preformed component of this invention can be implanted within an initial about one to about five minutes of the onset of its formation, and once implanted can be further molded or formed for a further period of about one to about five additional minutes, in a manner that permits the resultant implant to substantially retain a desired final form and function.
  • the present system simplifies the preparation process considerably, e.g., by lessening or avoiding potential problems (such as curing in the presence of moisture, and surface exotherm in the presence of tissue) that can arise when a comparable composition is mixed and delivered to the joint site while it is still flowable.
  • potential problems such as curing in the presence of moisture, and surface exotherm in the presence of tissue
  • the present system permits such prostheses to be not only formed, but also manipulated and inserted into the joint (e.g., through an incision of between about 1 cm and about 3 cm). Once inserted, the prosthesis can be positioned, and further formed in situ, all within a reasonable time frame. In fact, it has been found that the procedure is amenable to outpatient use and even regional anesthesia.
  • a balloon can be filled with a biomaterial as described herein, and inserted and positioned within the acetabulum, prior to or following filling, to provide a soft, conformable, durable lining for the placement of a hip prosthetic portion.
  • the method and system involve the preparation and use of one or more partially or fully cured component(s) formed outside the body, for insertion and placement into the body and optionally further fitting and securing at the joint site. These preformed component(s) typically require less manipulation at the bedside and allow for alternative methods of terminal sterilization, and final inspection and release at the manufacturing site.
  • the device is designed to be very hard, and based on such things as the concavity and convexity of various surfaces, which are designed to permit continued movement (translational and rotational) and repositioning of the device within the knee compartment in the course of use. In turn, the device is permitted and expected to continually move within the joint over the course of its use.
  • the present device can be used in patients having joints that have progressed to the stage of "bone on bone", and thus provides a replacement for the function of articular cartilage as well as meniscus, and particularly at the central weight-bearing area, in order to restore alignment.
  • the implant provides an elastomeric, cushioning function, as compared to the rigid and hard device of the '927 patent.
  • the present implant is also congruent with the tibial surface, based upon both its initial shape and the final shaping that occurs in situ. In turn, the present implant is more permanently anchored in place, in significant part by the posterior lip shown in Figures 1 , and 12 - 13 as well by the use of anterior fixation means (such as embedded sutures).
  • a method and system e.g., preformed component(s) and/or curable biomaterial and mold
  • a final prosthesis in vivo, that provides a first major surface in apposition to and retained upon the supporting bone itself, and a second (generally substantially parallel and opposite) major surface adapted to provide a wear surface for opposing (e.g., articulating) bone.
  • the first and second major surfaces can be provided in any suitable manner, for instance, 1) by the preparation and insertion of a single partially cured and generally preformed component into the joint, preferably under conditions that permit the component to become further, and specifically, formed in vivo, 2) by adding a flowable biomaterial to an initial preformed component (e.g., in the shape of a balloon or open mold) positioned at the tissue site, 3) by placing one or more fully cured and preformed components at the tissue site and optionally further fitting, adapting and/or securing the component(s) as needed, and/or 4) by assembling one or more preformed components in situ (e.g., side by side in an interlocking fashion upon the surface) such that the assembled components cooperate to provide the first and second major surfaces.
  • a flowable biomaterial e.g., in the shape of a balloon or open mold
  • Such biologically active agents can also include, for instance, antiinflammatory agents, antitumor agents, antibiotics, complement inhibitors, cytokines, growth factors, or inhibitors of growth factors and cytokines, as well as combinations of any such biologically active agents with each other and/or with adjuvants, and the like.
  • partially cured, and generally preformed components are inserted into the joint site, and there further and specifically formed to enhance compliance.
  • fully cured components in the shape of a balloon or open mold are employed to provide a final composite material by inserting the balloon or mold into the joint and there filling it with a biomaterial that cures in situ and conforms with the joint site.
  • the fully cured component(s) are provided and inserted into the joint either singly or piecemeal and optionally further fitted and secured in vivo.
  • the mold itself can be provided in a form sufficient to impart various integral structural features, such as tibial "tabs", adapted to provide or improve the retention of the component at the tissue site.
  • tabs can be provided in the form of one or more protrusions integral with the mold itself and adapted to be positioned within and/or affixed to the soft tissue and/or bone in vivo. Examples of such tabs are shown, for instance, in Figure 1 , where reference number 18 depicts a raised posterior portion.
  • An insertable component can also be provided with one or more ancillary portions or protrusions formed of materials other than that used to form the bulk of the component itself.
  • sutures or fibrous materials can be incorporated into or onto the bulk material, for use in improving the initial and/or long term retention of the component in situ, e.g, by tethering the prosthesis at the joint site and in a desired position.
  • Such other materials can be temporarily positioned into or upon the mold itself, for instance, or otherwise provided, in a manner that permits them to become integrated into the biomaterial as it fills the mold and becomes partially cured ex vivo.
  • the reinforcing material can be provided in any suitable form, e.g., as fibers (e.g., sutures) or as a uniform woven or non-woven fabric, optionally including one or more reinforcing fibers or layers.
  • a suitable non-woven fabric for instance, is preferably a material such as is commercially available under the trade name Trevira Spunbond from Hoechst Celanese Corporation.
  • the non-woven fabric is generally composed of continuous thermoplastic fiber, needle punched together to yield a felt-like fabric.
  • other materials such as polyester staple mat, glass fiber mat, as well as other organic and inorganic fiber mats and fabrics can be employed.
  • the fibers can be randomly oriented, or preferentially, they can be oriented in one or more directions, While a number of specific types of materials have been given for use as the reinforcing fiber layer, it will be appreciated by those of ordinary skill in the art that other equivalent-type reinforcing fiber layers can be employed in the practice of the invention.
  • a reinforcing fiber layer can be itself used to secure the prosthesis, or can be attached to a woven or non-woven fiber layer having a number of interstices or pores.
  • the reinforcing fiber layer and other fiber layers are secured to each other mechanically, as by conventional stitching, needle punching, stapling or buttons. In the case of certain applications, adhesives can also be used.
  • a partially cured preformed component (and/or ancillary) portions incorporated therein) can also be provided with suitable means to improve its ability to retain the component in situ, e.g., by the use of surface characteristics that provide improved chemical interactions with the joint site. Such interactions can be achieved by the judicious use of bulk material compositions themselves and/or the use of adhesives or other suitable interface materials.
  • the partially cured, preformed, component can also be physically modified to increase its interactions with joint site, as by surface roughening, etching or cross-hatching, which would tend to provide increased surface area, and in turn, improved mechanical retention.
  • a partially cured, preformed, component can also be retained by external means that are otherwise secured to the surrounding bone and/or soft tissue by use of adhesives, sutures, screws, pins, staples or the like or combinations thereof.
  • the partially cured preformed component can be provided with suitable means as well, intended to improve or alter either its compliance and/or interactions with the opposing bone surface.
  • the method and system described herein can be used for repairing a variety of mammalian joints, including human joints selected from the group consisting of the tibial plateau of the knee, the acetabulum of the hip, the glenoid of the shoulder, the acromion process of the shoulder, the acromio-clavicular joint of the shoulder, the distal tibial surface of the ankle, the radial head of the elbow, the distal radius of the forearm, the proximal phalanx surface of the great toe, the proximal metacarpal surface of the thumb, and the trapezium of the wrist.
  • human joints selected from the group consisting of the tibial plateau of the knee, the acetabulum of the hip, the glenoid of the shoulder, the acromion process of the shoulder, the acromio-clavicular joint of the shoulder, the distal tibial surface of the ankle, the radial head of the elbow, the distal radius of the
  • preformed component(s) that contact the bone surface are preferably adapted to physically conform closely to the prepared bone surface, e.g., to its macroscopic physical contours.
  • Such conformation can be provided or enhanced in any suitable manner, e.g., 1) by providing a partially cured preformed component that is first made in an ex vivo mold and then adapted or modified to conform to the surface (e.g., by further forming in vivo),- and/or 2) by use of a preformed balloon or composite mold material that is inserted into the joint site and filled with a flowable biomaterial that cures in invo so that it conforms with the joint site and/or 3) by the use of fully cured preformed component(s) that has optimum geometry for biomaterial compliance once placed in the joint site and/or 4) by the preparation and use of a suitable (e.g., thin) interface material between bone and preformed component (e.g., adhesive, filler, or cement material), and/or 5) by the use of physical restraining
  • the system can include the use of materials or markers (e.g., radiopaque) positioned within or upon the implant, to aid in visualization. e.g., using fluoroscopy or other X-ray techniques.
  • materials or markers e.g., radiopaque
  • the generally planar portions are provided with corresponding matable portions, e.g., in the form of grooves and tabs to provide a sliding fit, or a depression and corresponding projection to provide either a press fit, snap fit, or other suitable fit sufficient to prevent lateral displacement to the extent desired.
  • the resultant formed prosthetic implant can be provided with various features as described herein, including desired molded portions adapted to provide better fit or performance.
  • Top portion (31) is particularly well suited to provide a desirable wear surface, while one or more intermediate portions (as shown by element 32) are adapted to provide an optimal combination of such properties as thickness, cushioning, and angular correction.
  • preformed layers are shown having protrusions adapted to be positioned in a corresponding indentation within each underlying layer (or bone), in order to form a compact stack.
  • the corresponding system will typically include at least two preformed components, including the initial, bone contacting component, and final component providing the wear surface.
  • the system can provide one or more intermediate layers, e.g., the number and/or selection of which can be used to provide a final desired height to the overall composite, and/or to provide differing properties (e.g., with respect to compressibility, resilience, tissue ingrowth), and/or to provide improved retention between the first and final components.
  • Figure 6d shows a single piece (80) as might be cut from preformed material at the time of surgery
  • Figure 7 shows a variety of alternative means for anchoring a preformed component such as that shown in Fig. 6d .
  • a grout (82) or other suitable interface material as shown in Fig. 7a
  • a separate external retaining device (84) as shown in Fig. 7b
  • elements (86) which generally traverse the body itself as in Fig. 7c
  • anchor portions (88) positioned along one or more suitable surfaces as shown in Fig. 7d .
  • a femoral forming device of the type described in Applicant's previous US Provisional Application Serial No. 0/341,070 can be used to impart a textured surface.
  • the preformed components can benefit from any suitable combination of the various features and embodiments described or shown herein.
  • Figure 9 shows a variety of examples in a substantially closed (balloon like) mold is adapted to be inserted into the joint site and filled with a corresponding curable biomaterial, the mold itself providing a preformed articulating wear surface, including Fig. 9a which shows an inflatable balloon portion (96) that includes an integral preformed wear surface and portion (98), as well as a lumen (100) adapted to fill the inflatable portion with flowable biomaterial.
  • Fig. 9b shows a corresponding balloon (102) though without a preformed portion, and including its biomaterial lumen (104).
  • the balloon of this or any embodiment can include various interior and/or exterior surface coatings, and can have regions and/or layers having different desired physical-chemical properties (such as porosity).
  • Fig. 9c shows a bi-compartmental closed balloon-like mold (106), wherein each compartment is adapted to conform to a respective medial or lateral tibial surface.
  • Figure 10 shows a mold adapted for use as an acetabular mold (110) in connection with the replacement of the articulating surface in a hip, when filled with biomaterial, the mold forming a concave portion adapted to retain a corresponding femoral head.
  • the mold is shown providing a thin generally cup-shaped mold adapted to be filled in any suitable form (e.g., using a removable conduit (not shown) attached to the space between inner and outer sealed layers (116 and 114, respectively) forming the mold.
  • Figure 12 shows various views of a particularly preferred implant of the present invention, of the general type shown in Figure 1 and described above, including a top plan view (a), front plan view (b), side plan view (c), section view (d) taken-along A-A of Figure 12(a) and a section view (e) taken along C-C of Figure 12(a) .
  • Figure 13 shows side by side top plan views (a) and (b) of corresponding implants for the left and right knees, respectively.
  • An implant of the type shown provides various benefits, including the correction of varus deformities, based in significant part upon the presence and configuration of the posterior mesial lip (18), and the cutout (kidney bean shaped) for the intercondylar eminence (see Fig. 4b , ref 54).
  • the tibial projection (18) is adapted to catch the posterior portion of the tibial plateau.
  • the implant itself has dimensions as provided herein, and can be provided using one of a collection of molds of multiple sizes and/or styles in accordance with the various parameters of the present invention.
  • a kit can be provided containing molds of various sizes, e.g., varying by 1mm or 2mm increments in thickness and providing a range of anterior to posterior dimensions.
  • Such molds can also be used to provide implants having bottoms of various shapes, e.g., either a flat or curved bottom, and for either the left or right knee.
  • FIG. 14 A further preferred embodiment is shown with respect to Figure 14 , in which the posterior lip is shown as proceeding in a mesial direction so as to occupy the posterior -cruciate ligament sulcus when positioned in vivo .
  • Figure 14 (a) is a top view, with Figures 14(b) and 14(c) being sectional views taken along B-B and C-C, respectively.
  • the top of the implant provides a desired glide path, while the bottom of the implant is provided with a convex bottom configuration in order to better conform to the cavity of an arthritic posterior tibial plateau.
  • the mesial rim is raised approximately 2mm as compared to the embodiment of Figures 12-13 , with the highest point as it approaches the intercondylar eminence in order to add to stability and maintain the overall thickness of the implant.
  • the anterior portion of the implant is also provided with additional bulk, as compared to the embodiment of Figures 12-13 , providing it with a slightly wedge-shaped anterior region sloping from the base of the posterior lip to the anterior edge, in order to improve its posterior directional stability.
  • a slight amount of material is removed from the anterior mesial portion to form a cavity that is dimensioned so as to reduce the likelihood that the implant will impinge on the fermoral condyle and perhaps even the medial border of the patella.
  • the lip is lengthened a bit, so that with a 54 mm implant (measured as the longest dimension from the most anterior point to the upper inner radius or the posterior lip), the lip is shown as being on the order of 6 mm in height.
  • additional bulk is removed from the top, permitting the glide path to remain open in a posterior direction. This configuration allows for more complete flexion, lessening the extent to which the implant might impinge on the cartilage of the posterior medial femoral condyle, together with improved retention within the joint.
  • the tibial plateau is congruent to the bottom of the implant.
  • the tibial plateau is itself prepared to provide good fit on the tibial side of the implant, while the femoral surface of the implant can be smoothed and opened up so as to be amenable with most any femoral geometry.
  • Figure 16 shows various views of an implant in accordance with an exemplary embodiment of the present invention.
  • a distance A is shown extending from the most anterior point of the implant to the upper inner radius of the posterior lip of the implant.
  • a distance B is also illustrated in figure 16 .
  • Distance B may be described as the height of the posterior lip.
  • Distances C, D, and E are also illustrated in figure 16 .
  • the dimensions of the implant may be scaled to fit a particular size of patient.
  • distance A is about 54.0 mm
  • distance B is about 5.6 mm
  • distance C is about 7.0 mm
  • distance D is about 29.2 mm
  • distance E is about 2.1 mm.
  • distance A is, for example, between about 30 mm and about 60 mm.
  • distance B is, for example, between about 1 mm and about 10 mm.
  • distance C is, for example, between about 1 mm and about 10 mm.
  • distance D is, for example, between about 10 mm and about 40 mm.
  • distance E is, for example, between about 0.2 mm and about 4 mm.
  • Implants such as those described above are preferably used in a method that includes first determining the proper implant thickness needed to match physiological valgus.
  • the surgeon prepares the site arthroscopically, removing excess cartilage and removing the medial meniscus to the medial ring, using a portal of about 1 cm in order to provide suitable arthroscopic access while maintaining the presence of fluid in the joint.
  • the implant can be initially molded ex vivo, using a mold selected from those available and including one or more embedded or attached fixation portions (e.g., anterior sutures or tabs), at which time it is inserted into the knee.
  • surgeon will then typically feel the implant once in position, to confirm that the implant is properly seated, and will extend the knee to provide varus stress on the lower leg, obtaining congruency as the implant continues to cure by finally molding both surfaces of the implant (to both the tibial surface and condyle, respectively).
  • the surgeon can also use a femoral forming device (e.g., spoon-shaped device) of the type described in copending US Provisional Application mailed December 7, 2001 and entitled "Method and Device for Smoothing The Surface of Bone in an Articulating Joint", in order to prepare a femoral glide path and remove unwanted undulations.
  • a suitable time e.g., about 1 to about 5 minutes, and typically at about 2 minutes using presently preferred polyurethane compositions
  • the implant can be sutured to the anterior rim, and the knee can be flexed to obtain complete range.
  • the joint can be filled with a suitable fluid and visualized, after which the knee is extended and braced, with the access portal(s) closed by suitable means (e.g., sutured).
  • the present application describes a method and system for the creation or modification of the wear surface using an implanted material fixed to the support structure of the original wear surface, to generally conform to the shape of the original surface in a mammal.
  • a method or system where the end of the bony surface is a rotating, sliding or rolling surface, such as in the knee, finger, hip, toe, spine, wrist, elbow, shoulder, ankle, or TMJ joint.
  • the implant will function:
  • the material to be implanted consists of a plurality of materials, such as polymers, including polyurethane, polyethyelenes, polyureas, polyacrylates, polyurethane acrylates, hydrogels, epoxies and/or hybrids of any of the above.
  • the material would be semi-solid and could be shaped and then set up in vivo. This would allow for the minimally invasive application, either through an arthroscopic portal or through a small mini arthrotomy.
  • the material could be synthesized ex vivo and then machined to fit using imaging to pre-determine the desired geometry and size of the implant.
  • a range of implant sizes could be provided and sizing could be accomplished during the procedure.
  • An ex vivo mold could be fit using molding materials and the implant could be molded on site just prior to implantation.
  • Access to the site is obtained in a minimally invasive way. In a preferred embodiment, this is accomplished through arthroscopic means with arthroscopic portals. In an alternative embodiment, the access is accomplished by a mini arthrotomy with a small incision that allows access to the joint without sacrificing nerves, vessels, muscles or ligaments surrounding the joint. In the preferred example fibrillated articulating cartilage that is degenerated is removed down to the subchondral surface.
  • the surface is dried and prepared for appropriate anchoring. This may include anchor points that give a mechanical lock or that alternatively simply supply horizontal and lateral stability. The surface may be prepared by drying and roughening in case a tissue adhesive is used. Pre-made anchors may be installed.
  • Both the preformed component(s) and flowable biomaterial, if used, can be prepared from any suitable material.
  • the materials include polymeric materials, having an optimal combination of such properties as biocompatibility, physical strength and durability, and compatibility with other components (and/or biomaterials) used in the assembly of a final composite.
  • suitable materials for use in preparing the preformed component(s) may be the same or different from the in situ curing biomaterial, and include polyurethanes, polyethylenes, polypropylenes, Dacrons, polyureas, hydrogels, metals, ceramics, epoxies, polysiloxanes, polyacrylates, as well as biopolymers, such as collagen or collagen-based materials or the like and combinations thereof.
  • suitable materials for use in preparing the flowable biomaterial include but not limited bypolyurethanes, polyureas, hydrogels, epoxies, polysiloxanes, polyacrylates, and combinations thereof.
  • a biomaterial in the form of a curable polyurethane composition
  • a curable polyurethane composition comprising a plurality of parts capable of being mixed at the time of use in order to provide a flowable composition and initiate cure
  • the parts including: (1) a quasi-prepolymer component comprising the reaction product of one or more polyols, and one or more diisocyanates, optionally, one or more hydrophobic additives, and (2) a curative component comprising one or more polyols, one or more chain extenders, one or more catalysts, and optionally, other ingredients such as an antioxidant, hydrophobic additive and dye.
  • the composition is sufficiently flowable to permit it to be delivered to-the body, and there be fully cured under physiological conditions.
  • the component parts are themselves flowable, or can be rendered flowable, in order to facilitate their mixing and use.
  • the hard segments of the polymer can be formed by a reaction between the diisocyanate or multifunctional isocyanate and chain extender.
  • suitable isocyanates for preparation of the hard segment of this invention include aromatic diisocyanates and their polymeric form or mixtures of isomers or combinations thereof, such as toluene diisocyanates, naphthalene diisocyanates, phenylene diisocyanates (e.g. paraphenylene diisocyanate "PPDI" available from DuPont as Hylene PPDI), xylylene diisocyanates, and diphenylmethane diisocyanates, and other aromatic polyisocyanates known in the art.
  • aromatic diisocyanates and their polymeric form or mixtures of isomers or combinations thereof, such as toluene diisocyanates, naphthalene diisocyanates, phenylene diisocyanates (e.g. paraphenylene diisocyanate "PPDI" available from
  • an isocyanate that has low volatility such as diphenylmethane diisocyanate, rather than more volatile materials such as toluene diisocyanate.
  • An example of a particularly suitable isocyanate component is the 4,4'-diphenylmethane diisocyanate ("MDI").
  • MDI 4,4'-diphenylmethane diisocyanate
  • it can be provided in liquid form as a combination of 2,2'-, 2,4'- and 4,4'- isomers ofMDI.
  • the isocyanate is MDI and even more preferably 4,4'-diphenylmethane diisocyanate.
  • chain extenders for preparation of the hard segment of this invention include, but are not limited, to short chain diols or triols and their mixtures or combinations thereof, such as 1,4-butane diol, 2-methyl-1,3-propane diol, 1,3-propanediol ethylene glycol, diethylene glycol, glycerol, cyclohexane dimethanol, triethanol amine, and methyldiethanol amine.
  • chain extenders for preparation of the hard segment of this invention include, but are not limited to, short chain diamines and their mixtures or combinations thereof, such as dianiline, toluene diamine, cyclohexyl diamine, and other short chain diamines known in the art.
  • compositions include the following:
  • the PU can be chemically crosslinked, e.g., by the addition of multifunctional or branched OH-terminated crosslinking agents or chain extenders, or multifunctional isocyanates.
  • suitable crosslinking agents include, but are not limited to, trimethylol propane (“TMP"), glycerol, hydroxyl terminated polybutadienes, hydroxyl terminated polybutadienes (HOPB), trimer alcohols, Castor oil polyethyleneoxide (PEO), polytetramethyleneoxide triols and tetrols, polypropyleneoxide (PPO) and PEO-PPO triols.
  • This chemical crosslinking augments the physical or "virtual" crosslinking of the polymer by hard segment domains that are in the glassy state at the temperature of the application.
  • the optimal level of chemical cross-linking improves the compression set of the material, reduces the amount of the extractable components, and improves the biodurability of the PU.
  • This can be particularly useful in relatively soft polyurethanes, such as those suitable for the repair of damaged cartilage. Reinforcement by virtual crosslinks alone may not generate sufficient strength for in vivo performance in certain applications.
  • Additional cross-linking from the soft segment, potentially generated by the use of higher functional polyols can be used to provide stiffer and less elastomeric materials. In this manner a balancing of hard and soft segments, and their relative contributions to overall properties can be achieved.
  • a polymer system of the present invention preferably contains at least one or more, biocompatible catalysts that can assist in controlling-the curing process, including the following periods: (1) the induction period, and (2) the curing period of the biomaterial. Together these two periods, including their absolute and relative lengths, and the rate of acceleration or cure within each period, determines the cure kinetics or profile for the composition.
  • Suitable catalysts for preparation of the formed PU of this invention include, but are not limited to, tin and tertiary amine compounds or combinations thereof such as dibutyl tin dilaurate, and tin or mixed tin catalysts including those available under the tradenames "Cotin 222", “Formrez UL-22” (Witco), "dabco” (a triethylene diamine from Sigma Alarich), stannous octanoate, trimethyl amine, and triethyl amine.
  • the catalyst is Formrez UL-22 (Witco).
  • the catalyst is a combination Cotin 222 (CasChem) and dabco (Sigma-Aldrich).
  • the in vivo and ex vivo cured polyurethanes of this invention can be formed by the reaction of two parts.
  • Part I of which (alternatively referred to as Part A) includes a di- or multifunctional isocyanate or quasi-prepolymer which is the reaction product of one or more OH-terminated components, and one or more isocyanates.
  • Part II of the polyurethane (alternatively referred to as Part B herein) is a curative component that includes of one or more chain extenders and one or more polyols, and one or more catalysts, and other additives such as antioxidants and dyes.
  • the stoichiometry between Parts I (quasi-prepolymer) and II (curative component), expressed in terms of NCO:OH molar ratio of the isocyanate terminated pre-polymer (Part I) and the curative component (Part II) is preferably within the range of about 0.8 to 1.0 to 1.2 to 1.0, and more preferably from about 0.9 to 1 to about 1.1 to 1.0.
  • Suitable compositions for use in the present invention are those polymeric materials that provide an optimal combination of properties relating to their manufacture, application, and in vivo use.
  • properties include component miscibility or compatibility, processability, and the ability to be adequately sterilized or aseptically processed and stored.
  • suitable materials exhibit an optimal combination of such properties as flowability, moldability, and in vivo curability.
  • suitable compositions exhibit an optimal combination of such properties as strength (e.g., tensile and compressive), modulus, biocompatibility and biostability.
  • the compositions When cured, the compositions demonstrate an optimal combination of properties, particularly in terms of their conformational stability and retention of physical shape, dissolution stability, biocompatibility, and physical performance, as well mechanical properties such as load-bearing strength, tensile strength, shear strength, shear fatigue resistance, impact absorption, wear resistance, and surface abrasion resistance. Such performance can be evaluated using procedures commonly accepted for the evaluation of natural tissue and joints, as well as the evaluation of materials and polymers in general.
  • a preferred composition in its cured form, exhibits mechanical properties that approximate or exceed those of the natural tissue it is intended to provide or replace.
  • Part II of the two component system can include one long-chain polyols, chain extenders and/or cross-linkers, together with other ingredients (e.g., catalysts, stabilizers, plasticizers, antioxidants, dyes and the like).
  • Such adjuvants or ingredients can be added to or combined with any other component thereof either prior to or at the time of mixing, delivery, and/or curing.
  • a polymer system of this invention is provided as a plurality of component parts and employs one or more catalysts.
  • the component parts, including catalyst can be mixed to initiate cure, and then delivered, set and fully cured under conditions (e.g., time and exotherm) sufficient for its desired purpose.
  • the resultant composition Upon the completion of cure, the resultant composition provides an optimal combination of properties for use in repairing or replacing injured or damaged tissue.
  • the formulation provides an optimal combination of such properties as compatibility and stability of the biomaterial parts, ex vivo or in situ cure capability and characteristics (e.g., extractable levels, biocompatibility, thermal/ mechanical properties), mechanical properties (e.g., tensile, tear and fatigue properties), and biostability.
  • the volume ratio of the parts can also be used to improve and affect the uncured and curing properties Compositions having two or more parts, are preferred. Where two parts are used, the relative volumes can range, for instance, from 1:10 to 10:1 (quasi-prepolymer to curative components, based on volume). A presently preferred range is between 2:1 and 1:2. As those skilled in the art will appreciate, given the present description, the optimal volume ratio is largely determined by the compatibility and the stability of part A and B.
  • the viscosity of the reactive parts should provide an acceptable degree of mixing and flow rate, without causing mechanical failure of any component of the delivery system including cartridge, static mixer, gun and other components.
  • the biomaterial is sufficiently flowable to permit it to be delivered (e.g., injected) into the mold or tissue site.
  • the composition of both reactive parts must be such that these parts are homogeneous and phase stable in the temperature range of the application.
  • the maximum temperature of the reaction exotherm is proportional to the concentration of the reactive groups in the mixed polymer. A high concentration of the reactive groups might evolve too high reaction exothermal energy and therefore cause thermal damage to the surrounding tissues.
  • the reactive parts will preferably remain substantially liquid in form during mixing.
  • a desired and stable volume ratio of the components can be achieved in any suitable manner, e.g., by the use of dual-compartment cartridges with constant volume -ratio or by using the injectors with delivery rates independently variable for each component.
  • Compatibility of the composition can also be affected (and improved) in other ways as well, e.g., by pre-heating the components prior to polymer application.
  • the components of a preferred composition of this invention are preferably preheated before mixing and delivery, e.g., by heating to about 40 C, more preferably about 60 C, to about 80 C for about 2 to about 6 hours prior to use or for the time necessary for complete melting and forming of the member.
  • the composition parts are cooled back to about 35 C to 37 C before use in injection.
  • Fully cured polymeric (e.g., polyurethane) biomaterials suitable for use in forming components of this invention provide an optimal combination of such properties as creep and abrasion resistance.
  • the biomaterial provides DIN abrasion values of less than about 100 mm 3 , more preferably less than about 80 mm 3 and most preferably less than about 60 mm 3 , as determined by ASTM Test Method D5963-96 ("Standard Test Method for Rubber Property Abrasion Resistance Rotary Drum Abrader").

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Abstract

L'invention concerne un procédé et un système de création ou de modification de la surface d'usure d'articulation orthopédique, mettant en oeuvre la préparation et l'utilisation d'un ou de plusieurs composants partiellement ou complètement préformés et fournis, adaptés à être implantés et disposés dans le corps au site de l'articulation. Dans un mode de réalisation préféré, ce ou ces composants peuvent être partiellement durcis et généralement formés ex vivo, puis formés in vivo sur le site de l'articulation afin d'en améliorer la conformité et la performance à long terme. Dans un autre mode de réalisation, un ballon préformé ou un matériau composite peut être implanté sur le site de l'articulation et rempli d'un biomatériau fluide in situ afin de se conformer à l'articulation. Dans un mode de réalisation suivant, le ou les composants préformés peuvent être complètement durcis et formés ex vivo et éventuellement ajustés et fixés au site de l'articulation. Les composants préformés peuvent être suffisamment pliables afin de permettre leur insertion à travers une porte avec invasion minimale, et cependant assez souples pour assurer sensiblement, ou tendre vers, la forme recherchée in vivo avec mise en forme supplémentaire en place si nécessaire.

Claims (14)

  1. Un système pour la création ou la modification d'une articulation orthopédique à l'intérieur d'un corps mammifère, le système comportant un implant (10), adapté pour être inséré et positionné au niveau d'un site d'articulation, l'implant (10) ayant au moins une surface majeure en apposition à l'os de soutien, et au moins une deuxième surface majeure en apposition à l'os opposé,
    où l'implant (10) est un implant de genou et fournit une première surface majeure (10) adaptée pour être positionnée sur et congruente à la surface tibiale du genou, et une deuxième surface majeure (14) adaptée pour être positionnée contre le condyle fémoral du genou,
    et où la deuxième surface majeure est munie d'une trajectoire de descente fémorale (16) pour faciliter sa réalisation in situ, la trajectoire de descente (16) étant sous la forme d'une dépression généralement centrale,
    où l'implant (10) comporte de plus une ou plusieurs saillie(s) tibiale(s) (18) adaptée(s) pour s'étendre de façon distale sur le rebord du plateau tibial, caractérisé en ce que la ou les saillie(s) tibiale(s) est/sont adaptée(s) pour s'étendre dans une fosse de ligament croisé postérieur d'un tibia, grâce à quoi l'implant (10) reste essentiellement en place de façon permanente par rapport au plateau tibial.
  2. Un système selon la revendication 1 où l'implant (10) comporte un biomatériau unique.
  3. Un système selon la revendication 1 où la ou les saillie(s) tibiale(s) (18) est/sont adaptée(s) pour accrocher la portion postérieure du plateau tibial en s'étendant sur le rebord du plateau tibial de façon distale, et l'implant (10) a des dimensions de l'ordre d'entre 30 à 60 mm dans la dimension antérieure-postérieure, entre 20 mm et 40 mm dans la dimension médiale-latérale, et une épaisseur maximum, au niveau de la lèvre postérieure, d'entre 8 mm et 20 mm, ou de 3 mm à 10 mm de plus que l'épaisseur de l'implant (10) au centre.
  4. Un système selon la revendication 1 ou 2 où l'implant (10) comporte de plus au moins un composant auxiliaire (82, 84, 86, 88, 90, 92, 93, 94) intégré dans, et s'étendant partiellement à partir de, l'implant pour fournir une fixation antérieure.
  5. Un système selon la revendication 1 comportant de plus un ou plusieurs composant(s) séparé(s) (82, 84, 86, 88, 90, 92, 93, 94) pour assujettir l'implant au site d'articulation, sélectionné(s) dans le groupe composé des adhésifs, des sutures, des broches, des agrafes, des vis, et de combinaisons de ces derniers.
  6. Un système selon la revendication 2 où une pluralité d'implants sont fournis dans une gamme ou une pluralité correspondante de styles et de tailles en vue d'une sélection et d'une utilisation dans le domaine chirurgical.
  7. Un système selon la revendication 1 où l'implant comporte un matériau polymère.
  8. Un système selon la revendication 7 où le matériau polymère est du polyuréthane.
  9. Un système selon la revendication 1 ou 4, où l'implant comporte une ou plusieurs surface(s) ayant attaché à elle(s) un agent biologiquement actif sélectionné dans le groupe cytokines, facteurs de croissance, facteurs de croissance autologues, hydroxyapatite, collagène, et des combinaisons de ces derniers.
  10. Un système selon la revendication 1 ou 3 où la surface de l'implant est munie de ou modifiée avec des groupes réactifs pour favoriser l'adhésion tissulaire.
  11. Un système selon la revendication 10 où les groupes réactifs sont fournis par les polymères utilisés pour fabriquer le composant polymère, et sont sélectionnés parmi les amines, les groupes hydroxyles, ou autres fonctionnalités réactives ou de liaison hydrogène.
  12. Un système selon la revendication 1, 3, 4 ou 11 où la trajectoire de descente est sous la forme d'une dépression généralement centrale et ovale d'environ 0,5 mm à environ 5 mm de profondeur à son point le plus bas et d'environ 20 mm à environ 50 mm de longueur par 10 mm à 30 mm de largeur.
  13. Un système selon la revendication 1, où l'implant comporte un métal.
  14. Un système selon la revendication 13, où le métal est sélectionné dans le groupe composé du titane, de l'acier inoxydable, d'alliages cobalt chrome millithium et du tantale.
EP03703997A 2002-01-22 2003-01-22 Systeme d'arthroplastie avec interposition Expired - Lifetime EP1474071B1 (fr)

Applications Claiming Priority (10)

Application Number Priority Date Filing Date Title
US167963 1980-07-14
US98601 1987-09-14
US121455 1993-09-16
US34936702P 2002-01-22 2002-01-22
US349367P 2002-01-22
US10/098,601 US20020127264A1 (en) 2000-08-28 2002-03-15 Method and system for mammalian joint resurfacing
US10/121,455 US20020183850A1 (en) 2000-08-28 2002-04-12 Method and system for mammalian joint resurfacing
US10/167,372 US20020156531A1 (en) 1994-05-06 2002-06-11 Biomaterial system for in situ tissue repair
US40669502P 2002-08-29 2002-08-29
PCT/US2003/002142 WO2003061522A2 (fr) 2002-01-22 2003-01-22 Systeme et procede d'arthroplastie avec interposition

Publications (3)

Publication Number Publication Date
EP1474071A2 EP1474071A2 (fr) 2004-11-10
EP1474071A4 EP1474071A4 (fr) 2007-08-22
EP1474071B1 true EP1474071B1 (fr) 2010-05-19

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US (1) US20040247641A1 (fr)
EP (1) EP1474071B1 (fr)
JP (1) JP4324478B2 (fr)
AU (1) AU2010200382A1 (fr)
CA (1) CA2473858A1 (fr)
WO (1) WO2003061522A2 (fr)

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JP2005515810A (ja) 2005-06-02
EP1474071A2 (fr) 2004-11-10
CA2473858A1 (fr) 2003-07-31
AU2010200382A1 (en) 2010-02-25
WO2003061522A2 (fr) 2003-07-31
EP1474071A4 (fr) 2007-08-22
US20040247641A1 (en) 2004-12-09
JP4324478B2 (ja) 2009-09-02
WO2003061522A3 (fr) 2003-10-16
WO2003061522A9 (fr) 2005-04-28

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